The climatic causation of consumption : read in the Section of State Medicine at the Fortieth Annual Meeting of the American Medical Association, Newport, R.I., June, 1889 / by Henry B. Baker.
- Henry Brooks Baker
- Date:
- 1890
Licence: Public Domain Mark
Credit: The climatic causation of consumption : read in the Section of State Medicine at the Fortieth Annual Meeting of the American Medical Association, Newport, R.I., June, 1889 / by Henry B. Baker. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![Let us see how such an explanation would agree with the very different proportion of deaths from consumption which occur in the eight principal towns of Scotland. Taking a five years’ average (1857 to 1861 inclusive), it is found that, supposing all these towns are brought to an uniform population of 100,000 persons, there died annu- ally from consumption 206 persons in Leith, 298 in Edin- burgh, 310 in Perth, 332 in Aberdeen, 340 in Dundee, 383 in Paisley, 399 in Glasgow, and 400 in Greenock. The fact is, that if each town had been arranged in the order of comparative dryness of its site, they would almost have arranged themselves in the above position—Leith and Edinburgh the most free from consumption, and also having the dryest sites; Glasgow and Greenock the most ravaged by that disease, and beyond all comparison situ- ated on the dampest sites. The above fact, then, with regard to the towns, corroborates, in the most striking manner, the conclusions of Dr. Bowditch, and should be a valuable help to the sanitary reformers, as to the very important measures which it is their more especial prov- ince to carry out.' Referring to the conclusions based upon these investigations by Drs. Bowditch and Buchanan, Dr. R. Thorne Thorne, in his ‘ ‘ Progress of Pre ventive Medicine during the Victorian Era,” page 51, says: I am aware that, in his sixth report (1879) on the Com- bined Sanitary District of West Sussex, Dr. Charles Kel- ly, basing his views on certain experiences derived from that rural area, has expressed a doubt as to the correct- ness of these conclusions. He says that the phthisis death- rate has been “ distinctly lowered ” in that district “in recent years,” “ while very little, if any, change has taken place during the same period in the drainage of the soil.” Without entering into any criticism of some of the statis- tical data brought forward by Dr. Kelly in support of his views, I would here merely note, i, that a large amount of agricultural drainage which had then already been ef- fected throughout the kingdom would be expected to have produced a very similar result in rural districts to that brought about by sanitary drainage in towns; and 2, that Dr. Kelly offers no explanation of the definite and striking relations shown by Dr. Buchanan to have exist- ed between the amount of diminution of phthisis death- rate and the extent and permanence of the lowering of subsoil water. I have studied, with great interest, Dr. Kelly’s ‘‘Sixth Annual Report,” for West Sussex, pub- lished in 1880, as also one or two of his recent re- ports ; and although I do not conclude that the facts and considerations he publishes controvert those published by Drs. Bowditch and Buchanan, they are of value, and especially in suggesting that coincidently with considerable progress in improved sanitary conditions of the surroundings, such as improved water supply, drainage, sewer- age, etc., and improved methods of living, there has been apparently a great lessening of the mor- tality from consumption. Dr. Kelly says : The great difference in the amount of consumption is probably dependent upon several causes. The improved state of the cottages, the rise of wages leading to the children being better clothed and fed, the increase in railway communication, which tends to diminish inter- marriage, and to cause more interchange of population —all these changes, social as well as sanitary, have had their share in the improvement. In his Fourteenth Annual Report, page 188, Dr. Kelly says: 7 Tenth Report Medical Officer, Privy Council, 1S67, p. no. It cannot be maintained that [all] deaths which used to be registered as phthisis are now included under lung diseases, because although there is an increase under the latter head, it is by no means equal to the decrease under phthisis. Dr. Kelly, therefore, still claims that there has been an undoubted decrease of consumption in his jurisdiction. Dr. Kelly’s results reinforce the evidence here- tofore collected, as to the influence of nearly all sanitary improvements in decreasing consumption, but they do not seem to me to have any force toward breaking down the evidence collected by Drs. Bowditch and Buchanan. DR. pepper’s investigations, in PENNSYL- VANIA. Dr. Pepper’s ‘‘ Climatological Study of Con- sumption in Pennsylyania ” seems to have been well planned, and carefully executed, but it did not yield results as convincing on the subject of the relation of soil moisture to consumption as did the investigations by Drs Bowditch and Bu- chanan, probably because of less perfect records of vital statistics in Pennsylvania, and perhaps also because of less attention having been given to the subject by local physicians in that State. A few selections may be instructive: It will be observed at once that those portions of the State where phthisis is rarest are the most elevated, hav- ing a general altitude of 1,500 to 2,000, or, better still, of 2,000 to 3,000 feet; while, in proportion as we enter dis- tricts of lower general altitude, we find correspondingly increasing rates of mortality from consumption.® It may be noted that in Erie county, which has consid- erable average elevation, the mortality may be influenced by the proximity of the lake, and by the presence of a considerable body of low, wet land. It will be seen further on, in the more minute study we have been able to make of Philadelphia, that the influ- ence of elevation and of density of population appears to be considerable, and in accordance with what we have above stated.” Dr. Bowditch and Dr. Buchanan each gathered evidence, from several sources, the combined force of which was very great, and after their results were united their conclusions were irresistible. As they have never been successfully controvert- ed, it seems probable that the laws which they formulated will stand as a secure foundation upon which we may safely build. Wm. Pepper, M.D., EL.D., the distinguished Provost of the Univer- sity of Pennsylvania, has said : It is manifestly difficult to subject this theory to search- ing and conclusive investigation; but, so far as investiga- tion has been made in other portions of this country or abroad, the evidence has tended to confirm Dr. Bowditch’s position.'” But, if the grand truth, for which we are so much indebted to him, is really a truth, how comes it that the great reduction in consumption which should have followed its discovery has been as yet so little realized? There are, prob- 8 Trans. Am. Climatological Assoc., May, i886. New York, 1887, p. 98. 9 Page 99. *0 Trans. Am. Climatological Assoc., 1887, p. 88.](https://iiif.wellcomecollection.org/image/b22416341_0007.jp2/full/800%2C/0/default.jpg)
